CLINICAL RESEARCH: CARDIAC IMAGING
Role of Left Atrial Size in Risk Stratification and Prognosis of Patients Undergoing Stress Echocardiography
Sripal Bangalore, MD, MHA,
Siu-Sun Yao, MD, FACC and
Farooq A. Chaudhry, MD, FACC*
Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital and Columbia University, New York, New York
Manuscript received January 16, 2007;
revised manuscript received June 15, 2007,
accepted June 25, 2007.
* Reprint requests and correspondence: Dr. Farooq A. Chaudhry, Director of Echocardiography, Division of Cardiology, Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, New York 10025. (Email: fchaudhr{at}chpnet.org).
This work was presented in part at the 2006 Annual Scientific Session of the American Society of Echocardiography, June 3–7, 2006, Baltimore, Maryland.
Objectives: The purpose of this study was to evaluate the role of diastolic dysfunction as measured by left atrial (LA) size in patients undergoing stress echocardiography (SE).
Background: Left atrial size is a surrogate marker of diastolic function. However, its prognostic value in patients referred for SE is not well defined.
Methods: We evaluated 2,705 patients (60 ± 13 years, 47% men) undergoing SE (56% dobutamine). Patients with significant mitral valve disease (mitral stenosis or  moderate mitral regurgitation) were excluded. Enlarged LA was defined as a LA size indexed to body surface area 2.4 cm/m2. Follow-up (mean 2.7 ± 1.0 years) for nonfatal myocardial infarction or cardiac death (n = 122) was obtained.
Results: A dilated LA was able to further risk-stratify both the normal and abnormal SE groups. In the presence of a dilated LA, an abnormal SE portends a worse prognosis compared with patients with normal LA size. Cox proportional modeling showed that a dilated LA added incremental value over traditional risk factors, stress electrocardiographic, rest echocardiographic, and SE variables for the prediction of hard events (global chi-square increased from 90.4 to 113.1 to 176.1 to 184.4 to 190.5; p < 0.05 all groups). Left atrial size was a significant predictor of events independent of left ventricular systolic dysfunction and ischemia (relative risk = 1.84, 95% confidence interval 1.19 to 2.85; p = 0.006).
Conclusions: In patients referred for stress echocardiography, LA size provides independent and incremental value over standard risk factors including left ventricular systolic dysfunction and ischemia. Left atrial size is a powerful prognosticator and should be routinely used in the prognostic interpretation of stress echocardiography.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | ECG = electrocardiogram | | ICC = interclass correlation | | LA = left atrial/atrium | | LV = left ventricular | | MI = myocardial infarction | | RR = risk ratio | | WMSI = wall motion score index |
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